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Hydatid disease is a zoonotic disease, mainly prevalent in endemic countries. The liver and lungs are the most commonly affected organs in hydatid disease. Primary hydatid cyst of the pancreas is rare, and pancreatitis due to hydatid cyst has rarely been listed in the literature. Hydatid cyst of the pancreas is difficult to diagnose preoperatively. It can be misdiagnosed as a pseudocyst of the pancreas. We report the case of a 32-year-old female patient who presented with recurrent acute pancreatitis. Following preoperative imaging, the primary impression was a pancreatic pseudocyst. On further evaluation with endoscopic ultrasound-guided fine needle aspiration (FNA) and hydatid serology, she was diagnosed with a pancreatic hydatid cyst. Laparoscopic partial pericystectomy was performed. In literature, pancreatic hydatid cysts were mainly treated with a traditional open surgical approach. A minimally invasive surgical approach is evolving as an option in selected cases of pancreatic hydatid cysts.
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Background In gallbladder cancer (GBC), extrahepatic bile duct (EHBD) resection is selectively performed if gross direct extension or microscopic involvement of the cystic duct margin (CDM) is detected. Although CDM is usually sent for frozen biopsy intraoperatively in most centers, there are no studies regarding the routine use of CDM frozen biopsy irrespective of the tumor location and paucity of literature regarding the impact of CDM status on recurrence-free and overall survival in GBC. The presence of obstructive jaundice in GBC usually indicates the involvement of EHBD or cystic duct-bile duct junction. The present study aimed to analyze the necessity of routine CDM frozen biopsy in patients with resectable GBC without jaundice, regardless of the tumor location. The impact of positive CDM on survival was also evaluated. Methods This retrospective observational case-control study was conducted from May 2009 to March 2021 and included 105 patients with resectable GBC without macroscopic EHBD infiltration and jaundice. Patients were divided into CDM-negative (n=91) and CDM-positive (n=14) groups. Propensity score matching was performed for variables such as performance status, tumor size, tumor-node-metastasis (TNM) stage, and adjuvant chemotherapy. After propensity score matching, 27 patients (CDM-negative=13, CDM-positive=14) were included. The primary outcome was to analyze the role of routine CDM frozen biopsy regardless of tumor location, and secondary outcomes were to study the impact of positive CDM status on survival and evaluate predictive factors for CDM positivity. A subgroup analysis was conducted to assess clinicopathologic characteristics and outcomes of the anatomical location of the tumor. Results Of 105 patients, 91 had negative CDM, and 14 had positive CDM. Among 14 patients with positive CDM, only one patient had a tumor in the fundus/body, and the remaining had a tumor involving the neck. All CDM-positive patients underwent bile duct excision with hepaticojejunostomy. Common bile duct (CBD) involvement was present in 50% of patients with positive CDM in the final histopathological examination. In the matched population, patients with positive CDM had a significantly higher rate of neck tumors (p=0.001). Recurrence-free survival (24 vs. 12 months, p=0.30) and overall survival (24.5 vs. 20 months, p=0.417) were comparable between CDM-negative and CDM-positive groups, respectively. On multivariate analysis, preoperative and intraoperative tumor location were independent predictive factors for CDM positivity. On subgroup analysis, 30 patients had tumor involving the neck of the gallbladder, and the remaining 75 had at the fundus and body of the gallbladder. Neck tumors had inferior recurrence-free survival (17 vs. 30 months, p=0.012) and overall survival (24 vs. 36 months, p=0.048) compared to non-neck tumors. Conclusions Routine use of CDM frozen analysis in patients with resectable GBC without jaundice, regardless of tumor location, can be avoided. It can be selectively preferred in patients with GBC involving the neck since tumor location is found to be an independent predictive factor for CDM positivity. Positive CDM has comparable survival outcomes to negative CDM, providing a similar R0 resection rate and tumor stage. However, neck tumors have a worse prognosis than non-neck tumors.
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Background Patients with gallbladder carcinoma (GBC) and jaundice have a poor prognosis. The surgical management of these patients is controversial. There is a dearth of studies comparing curative surgical resection (CR) versus non-curative resection/palliation (NCR) in patients with GBC and jaundice. Hence, this study aimed to compare the outcomes between CR and NCR in these patients. Methodology This was a retrospective study on patients with GBC and jaundice managed by a single surgical unit at a tertiary care center in northern India from May 2009 to March 2021. These patients were grouped into CR or NCR. The clinical demographical profile and overall survival (OS) were compared between the groups. Results A total of 82 patients with GBC and jaundice were managed during the study period. The final study cohort included 59 patients (CR, n = 34; NCR, n = 25) after excluding patients with metastatic disease (n = 23). Common bile duct infiltration was seen in 61.7% and 84% of CR and NCR patients, respectively (p = 0.062). The overall tumor-node-metastasis staging between the two groups was similar (p = 0.296). The median OS of CR was significantly better in CR than NCR (20 months vs. six months; p = 0.001). The median OS was better in CR than NCR patients who received systemic chemotherapy (22 vs. 12 months; p = 0.001) or did not receive chemotherapy (14 months vs. three months; p = 0.001). Conclusions Patients with GBC and jaundice have better significant survival after CR than NCR alone.
